Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy

McMillan, Matthew T.; Soi, Sameer; Asbun, Horacio J.; Ball, Chad G.; Bassi, Claudio; Beane, Joal D.; Behrman, Stephen W.; Berger, Adam C.; Bloomston, Mark; Callery, Mark P.; Christein, John D.; Dixon, Elijah; Drebin, Jeffrey A.; Castillo, Carlos Fernández del; Fisher, William E.; Fong, Zhi Ven; House, Michael G.; Hughes, Steven J.; Kent, Tara S.; Kunstman, John W.; Malleo, Giuseppe; Miller, Benjamin; Salem, Ronald R.; Soares, Kevin C.; Valero, Vicente; Wolfgang, Christopher L.; Vollmer, Charles M.

doi:10.1097/sla.0000000000001537

Cited by 157 publications

(86 citation statements)

References 45 publications

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“…It was seen that studies which included Grade A fistulas have twice the POPF rates when compared to studies which included only clinically relevant Grade B and C fistulas. 4 Also some surgeons do not place intraperitoneal drains following pancreaticoduodenectomy and hence diagnosis of Grade A fistulas in these patients is not possible. Hence, we need to have a definition which would actually focus only on clinically relevant POPF and avoid discrepancy in reporting the POPF rates.…”

Section: Discussionmentioning

confidence: 99%

“…Studies which have included Grade A fistulas have twice the POPF rates when compared to studies which have excluded Grade A POPF. 4 Hence there is a discrepancy in literature regarding the exact incidence of POPF following Pancreaticoduodenectomy. When a clinician reports POPF rates in their study, we do not know whether it is overall POPF or only clinically relevant POPF i.e.…”

Section: Introductionmentioning

confidence: 98%

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Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

et al. 2017

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Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

et al. 2017

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“…Los grados B y C se consideran actualmente como clínicamente relevantes 17 , y éstas son las que consideramos al evaluar la morbilidad posoperatoria.…”

Section: Fístula Pancreática Posoperatoria (Fppo)unclassified

Pancreatoyeyunoanastomosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía. Estudio de serie de casos con seguimiento

et al. 2018

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Introduction:Pancreatoduodenectomy is a complex surgery, with morbidity close to 30% and mortality between 1% and 5%. The main contributing factor to morbidity and mortality is postoperative pancreatic fistula (POPF). At present, there is no globally standardized technique for pancreatic reconstruction. Aim: To determine the prevalence of clinically relevant POPF in a sample of patients who underwent pancreaticojejunal anastomosis reconstruction with Blumgart's modified technique for post-pancreatoduodenectomy reconstruction at Hospital Hernán Henríquez Aravena between 2014 and 2017. Material and Method: Case series with follow-up from july 2014 to april 2017. Patients who underwent pancreatic reconstruction with Blumgart's modified technique were included. The modification consisted of the use of Pledgets ® (poly-tetrafluoro-ethylene) at the inicial points in páncreas with the idea of reducing the possibility of tissue tearing. We excluded patients who underwent another reconstruction technique. Clinically relevant POPF (grade B/C) was considered to asses morbidity. Descriptive statistics were used with measures of central tendency and dispersion. Results: Case series of 12 patients, 9 (75%) were female and 3 (25%) were male. The mean age was 59 ± 8.5 years. The morbidity was 25% and the rate of grade B/C fistula was 0%. All pancreatic fistulas were grade A, not clinically relevant. Conclusion: The Blumgart's modified technique seems to be a safe and reproducible technique for pancreticojejunal anastomosis.

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“…Recent improvements in operative techniques and perioperative management have substantially decreased postoperative mortality rates to < 5% [1, 2]. Nevertheless, the postoperative morbidity rate remains high (30–50%), even in high-volume cen ters [3, 4]. Postoperative pancreatic fistula (POPF) is the most common major complication of PD, with a frequency ranging from 2 to 20% [3, 4].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the postoperative morbidity rate remains high (30–50%), even in high-volume cen ters [3, 4]. Postoperative pancreatic fistula (POPF) is the most common major complication of PD, with a frequency ranging from 2 to 20% [3, 4]. POPF can lead to abscess formation, vascular injuries, pseudoaneurysm rupture, fatal hemorrhage, and sepsis.…”

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

Miyamoto

Oshiro

Sano

et al. 2018

Gastrointest Tumors

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Background: Postoperative pancreatic fistula (POPF) is a serious complication that can occur following pancreaticoduodenectomy (PD). Recent studies suggest that remnant pancreatic volume (RPV) values from preoperative multidetector computed tomography (MDCT) are highly predictive of POPF. We performed three-dimensional (3D) surgical simulation of PD including RPV measurements. The aim of this study was to determine whether 3D-measured RPV is predictive of POPF after PD. Methods: We used the SYNAPSE VINCENT® medical imaging system (Fujifilm Medical Co., Ltd., Tokyo, Japan) to construct 3D images after integrating MDCT and magnetic resonance cholangiopancreatography images. RPV was measured using this 3D image, which simulated actual intraoperative pancreatic parenchymal remnant volume. Ninety-one patients who underwent PD were retrospectively enrolled. Using multivariate analysis, RPV and other well-known POPF risk factors were independently assessed. Results: Multivariate analysis identified high RPV values (hazard ratio [HR] = 8.41, p = 0.01), pancreatic duct diameter < 3.0 mm (HR = 5.48, p < 0.01), no pathological fibrosis (HR = 3.41, p < 0.01), and body mass index > 25 kg/m² (HR = 1.53, p = 0.02) as independent risk factors for POPF. Conclusion: The present study indicates that preoperative 3D-measured RPV is predictive of POPF after PD.

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Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy

Cited by 157 publications

References 45 publications

Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

Pancreatoyeyunoanastomosis con técnica de Blumgart modificada para reconstrucción post-pancreatoduodenectomía. Estudio de serie de casos con seguimiento

Three-Dimensional Remnant Pancreatic Volumetry Predicts Postoperative Pancreatic Fistula in Pancreatic Cancer Patients after Pancreaticoduodenectomy

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